Mid-Life

Perimenopause
Menopause

Perimenopause

Perimenopause is the time leading up to menopause (menopause is defined as the absence of a period for twelve months). During perimenopause, your body starts making less of certain hormones (estrogen and progesterone), and you begin to lose the ability to become pregnant.

How long does perimenopause last?

It varies. Women normally go through menopause between ages 45 and 55. Many women experience menopause around age 51. However, perimenopause can start as early as age 35. It can last just a few months or a few years. There is no way to tell in advance how long it will take you to go through it.

Symptoms of perimenopause

Some women have symptoms during this time that can be difficult. These symptoms can include:

Changes in your menstrual cycle (longer or shorter periods, heavier or lighter periods, or missed periods)
Hot flashes (sudden rush of heat from your chest to your head)
Night sweats (hot flashes that happen while you sleep)
Vaginal dryness
Sleep problems
Mood changes (mood swings, depression, irritability)
Pain during sex
More urinary infections
Urinary incontinence
Less interest in sex
Increase in body fat around your waist
Problems with concentration and memory

What are hot flashes?

We don't know exactly what causes hot flashes. It could be a drop in estrogen or change in another hormone. This affects the part of your brain that regulates your body temperature. During a hot flash, you feel a sudden rush of heat move from your chest to your head. Your skin may turn red, and you may sweat. Hot flashes are sometimes brought on by things like hot weather, eating hot or spicy foods, or drinking alcohol or caffeine. Try to avoid these things if you find they trigger hot flashes.

Relieving the symptoms of perimenopause

Keep a journal for a few months and write down your symptoms, like hot flashes, night sweats and mood changes. That can help you figure out the changes you're experiencing.
Record your menstrual cycle, noting whether you have a heavy, normal or light period.
Find a physical activity you enjoy doing.
If you smoke, try to quit. RMH offers a number of smoking cessation programs. For more information, call RMH HealthSource at (540) 564-7200.
Keep your body mass index (BMI) at a normal level. Calculate your BMI by visiting RMHOnline.com BMI calculator.
Talk to your friends who are in perimenopause or menopause. Most likely, they're going through the same things you are!
Do something new—volunteer or take a class.
Use a vaginal lubricant for dryness and pain during sex.
Dress in layers.
Try to figure out if certain triggers cause hot flashes, like spicy foods or being outside in the heat. Avoid these things.
Talk with your healthcare provider if you feel depressed or have any other questions about how to relieve your symptoms.

Pregnancy during perimenopause

If you're still having periods, you can get pregnant while in perimenopause. Talk to your healthcare provider about your options for birth control. More information>>

The source for the above information on perimenopause was the US Department of Health and Human Services, Office on Women’s Health, www.4women.gov/faq/perimenopause.htm

You can find out more about perimenopause by contacting the National Women's Health Information Center at 800-994-WOMAN (9662).

Menopause

Menopause is a normal change in a woman’s life when her period stops. During menopause, a woman’s body slowly makes less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row (and there are no other causes for this change). As you near menopause you may have symptoms from the changes in your body. Many women wonder if these changes are normal, and many are confused about how to treat their symptoms. You can feel better by learning all you can about menopause, and talking with your doctor about your health and your symptoms. If you want to treat your symptoms, he or she can teach you more about your options and help you make the best treatment choices.

Symptoms of Menopause

For every woman, monthly periods will stop at menopause. Some women may not have any other symptoms. But as you near menopause, you may have:

Changes in your period—the time between periods and the flow from month to month may be different.
Abnormal bleeding or “spotting". If your periods have stopped for 12 months in a row and you still have “spotting,” you should report this symptom to your doctor to rule out serious causes, such as cancer.
Hot flashes—getting warm in the face, neck and chest.
Night sweats and sleeping problems.
Vaginal changes—the vagina may become dry and thin, and sex and vaginal exams may be painful. You also might experience more vaginal infections.
Thinning of your bones—this may lead to loss of height and bone breaks (osteoporosis).
Mood changes.
Urinary problems—such as leaking, burning or pain when urinating, or leaking when sneezing, coughing or laughing.
Problems with concentration or memory.
Less interest in sex and changes in sexual response.
Weight gain or increase in body fat around your waist.
Hair thinning or loss.

Induced/Surgical Menopause

Sometimes, younger women need a hysterectomy (surgery to remove the uterus and ovaries) to treat health problems such as endometriosis or cancer. After your surgery, you will enter into what is known as induced or surgical menopause. This is menopause that happens to your body right away, and it is brought on by the surgery. You will no longer have periods. Since your ovaries will be removed, you may have many menopausal symptoms right away, instead of gradually. You can talk with your doctor about how to best manage these symptoms.

Women who have a hysterectomy but retain their ovaries will not experience induced menopause because their ovaries will continue to make hormones. But, because their uterus is removed, they no longer have their periods and they cannot bear children. They may also have hot flashes, since the surgery can sometimes disturb the blood supply to the ovaries. They may experience natural menopause a year or two earlier than expected.

Premature Menopause

Premature menopause is menopause that happens before the age of 40—whether it is natural or induced. Some women have premature menopause because of:

family history (genes)
medical treatments, such as surgery to remove the ovaries
cancer treatments, such as chemotherapy or radiation to the pelvic area

Postmenopause

The term postmenopause refers to the years beyond menopause. It is the period past the time at which you have not had a period for 12 months in a row — whether your menopause was natural or induced.

Depression and Menopause

Many women in perimenopause and menopause feel depressed and irritable. Some researchers believe that the decrease in estrogen triggers changes in your brain, causing depression. Others think that other symptoms you're having, such as sleep problems, hot flashes, night sweats, and fatigue cause these feelings. Or, it could be a combination of hormone changes and symptoms. But these symptoms also can have causes that are unrelated to menopause. If you are having these symptoms and they are interfering with your quality of life, it is important that you discuss them with your doctor. Talk openly with your doctor about the other things going on in your life that might be adding to your feelings.

Bleeding After Menopause

Changes in bleeding are normal as you near menopause. There are also other common causes of bleeding in the years after menopause. The decline in your body's estrogen levels can cause tissues lining the vagina to become thin, dry, and less elastic. Sometimes this lining can become broken or easily inflamed and bleed. It can also become injured during sex or even during a pelvic exam. Once you've reached menopause, though, you should report any bleeding that you have to your doctor. Uterine bleeding after menopause could be a sign of other health problems. Other things that can cause abnormal bleeding include:

fibroids
the use of birth control pills
a hormonal imbalance
non-cancerous growths in the lining of the uterus

Treatment for the Symptoms of Menopause

For some women, many of their menopause symptoms will go away over time without treatment. Other women will choose treatment to address their symptoms and to prevent bone loss that can happen near menopause. Treatments may include prescription drugs that contain the hormones your ovaries stop making around the time of menopause. Hormone therapy can contain estrogen alone or estrogen with progestin (for a woman who still has her uterus). Estrogen therapy usually is taken by pill, skin patch, as a cream or gel, or is delivered through an intrauterine device (IUD) or vaginal ring.

For more information about hormone therapy, including benefits and risks, speak with your doctor.

Other Ways to Relieve Symptoms

Hot flashes—Try to avoid a hot environment, eating or drinking hot or spicy foods, alcohol, caffeine and stress. Dress in layers and keep a fan in your home or workplace. Regular exercise may also relieve hot flashes and other symptoms. Ask your doctor about taking an antidepressant medicine. There is proof that these can be helpful for some women.
Vaginal dryness—Use an over-the-counter vaginal lubricant. Your doctor may also prescribe prescription estrogen replacement cream.
Problems sleeping—One of the best ways to get a good night's sleep is to get at least 30 minutes of physical activity on most days of the week, but avoid a lot of exercise close to bedtime. Also avoid alcohol, caffeine, large meals and working right before bedtime. You might want to drink something warm, such as herb tea or warm milk, before bedtime. Try to keep your bedroom at a comfortable temperature. Avoid napping during the day and try to go to bed and get up at the same times every day.
Memory problems—Ask your doctor about mental exercises you can do to improve your memory. Try to get enough sleep and be physically active.
Mood swings—Try to get enough sleep and be physically active. Ask your doctor about relaxation exercises you can do. Ask your doctor about taking an antidepressant medicine. There is proof that these can be helpful. Think about going to a support group for women who are experiencing the same things or seek counseling to talk through your problems and fears.

The source for the above information on menopause was the US Department of Health and Human Services, Office on Women’s Health, www.4women.gov/faq/perimenopause.htm

You can find out more about menopause by contacting the National Women's Health Information Center at 800-994-WOMAN (9662).

In This Section